Provider Demographics
NPI:1760881189
Name:NIAMKE, CHAQUITA (PSYS)
Entity Type:Individual
Prefix:MRS
First Name:CHAQUITA
Middle Name:
Last Name:NIAMKE
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 WARRENSVILLE CENTER RD STE 211
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3146
Mailing Address - Country:US
Mailing Address - Phone:216-273-9933
Mailing Address - Fax:
Practice Address - Street 1:2260 WARRENSVILLE CENTER RD STE 211
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3146
Practice Address - Country:US
Practice Address - Phone:216-273-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3151577103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool